Dutch researchers skip radiation treatments, some chemo but add corticosteroid
THURSDAY, Sept. 10 (HealthDay News) -- Adding the corticosteroid dexamethasone to the treatment regimen of children with acute lymphoblastic leukemia improves survival rates and reduces the incidence of the cancer recurring, a new Dutch study shows.
Acute lymphoblastic leukemia (ALL), a cancer of the blood, is the most common childhood cancer and is highly treatable, according to background information in the study.
But the researchers say that many children with ALL are over-treated with cranial radiation and chemotherapy drugs that cause significant side effects and may not be necessary to cure them.
The study found that a dexamethasone-based treatment can improve the cancer cure rate and reduce the risk of relapse without radiation and routinely used chemotherapy drugs. The findings were published online Sept. 9 The Lancet Oncology.
Dexamethasone is sold under the brand name Decadron.
The study involved 859 youths, aged 1 to 18, with ALL. About 30 percent of them were considered to be at high risk for recurrence.
Participants not at high risk were given a basic three-drug induction (dexamethasone, vincristine and L-asparaginase) and medium-dose methotrexate. High-risk youths were given a four-drug induction (the same three drugs as the others got plus four doses of daunorubicin), consolidation with methotrexate and two intensification courses before maintenance, which was 109 weeks for all participants.
Triple intrathecal chemo was given 13 times in those not at high risk, 15 times in high-risk youths and 17 times in those with initial central nervous system involvement. No one was given cranial radiation.
Five-year, cancer-free survival for the high-risk group was 72 percent, the study found. Those not at high risk had an 84 percent survival rate. About 70 percent of all people newly diagnosed are not at high risk, according to the researchers.
The results for those not at high risk "were achieved with high cumulative doses of dexamethasone and vincristine, but without the use of anthracyclines, etoposide, cyclophosphamide or cranial irradiation, therefore minimizing the risk of side effects," they said in a news release from the journal. The survival rate for the high-risk group also was described as favorable.
The U.S. National Cancer Institute has more on acute lymphoblastic leukemia.
-- Jennifer Thomas
SOURCE: The Lancet Oncology, news release, Sept. 9, 2009
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